Meniscus Repair

meniscus repair Lithuania in private clinic
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Anatomy of knee joint
When necessary?
When to avoid?
Meniscus repair techniques
Recovery
Complications
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2.000 € / 1.600 £ / 2.600 $

(meniscus repair surgery)

Meniscus repair surgery is a surgical treatment of torn meniscus. The aim of this surgery is to fix a defect of the meniscus without removing it.

Anatomy of knee joint

The meniscus is a structure in the knee joint located between the femur (also known as the thighbone) and the tibia (the shinbone). It is a semi-lunar or letter “C“ shaped construction which is composed of a cartilaginous and white fibrous tissues. Each of the knee joints has two menisci: medial and lateral. They serve as a shock absorbers and buffers energy of movements which can damage articular structures. Moreover, the menisci reduce a bone to bone friction in this way preventing the femur and the tibia from wearing down.

When meniscus repair is necessary?

The main and probably the only indication for the meniscus repair surgery is the tear of the meniscus. It is an exceedingly common knee injury. Usually the meniscus is torn due to a trauma. The reason can also be degenerative processes, especially in older people. However, in this case, meniscus repair surgery is contraindicated.

A traumatic injury of meniscus occurs when the person forcefully twists his or her knee while it is bend. The other mechanism is when the person twists the knee while the foot is planted on the ground. A torn meniscus gives symptoms such as pain, swelling, stiffness and limited motion of the knee. Additionally, some people recall a popping sensation at the time of the injury.

Once the torn meniscus is diagnosed, the treatment must be administered. The initial treatment of the torn meniscus is conservative and includes rest, cold therapy, compression and elevation of the injured leg. If the injury is mild, the conservative therapy helps enough and the meniscus recovers on its own. However, if the knee remains painfull and the motion of it is still limited, the surgical treatment is recommended.

The surgical treatment can be focused on the reconstruction (meniscus repair surgery) or on the removal (meniscectomy) of the damaged meniscus. Saving the meniscus is very important because it decreases the risk of secondary osteoarthritis, especially in young patients. However, there are several factors which determine what type of the operation will be performed. First, the crucial factor is the location of the tear of the meniscus. The ideal location of the tear to choose the meniscus repair surgery is the periphery of the meniscus. Further, the other criterion is the size of the tear. If it is shorter than 2 cm, the repairing surgery can be performed.

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When meniscus repair should not be performed?

In certain cases meniscus repair is not advisable. For instance, in case of degenerative tear of the meniscus, a tear greater then 2 cm, unstable knee with anterior cruciate ligament deficiency, a local infection or degenerative joint disease, patient older then 40 years. Moreover, it is important how acute the tear is because chronic tears often become degenerative and crumbled and are no longer suitable for repair.

Techniques: Open, Arthroscopic

The meniscus repair surgery can be classified into three generations. Each of them involves different surgical techniques.

Open surgery

The first generation meniscus repair surgery concerns an open technique. Using the open technique, the capsule and the synovium of the knee joint are incised and opened in order to see the tear of the meniscus. This makes the first generation different from other meniscus repair generations.

Arthroscopic

The second generation meniscus repair surgery involves arthroscopically assisted technique. Since modern medicine is focused on the minimal invasive methods of treatment, this type of surgery is mostly used in nowadays. An arthroscope is a small fiber-optic instrument which enables the surgeon to inspect and operate the knee from inside without opening the capsule and synovium.

The first step of the second generation meniscus repair is called debridement. It is a removal of lacerated tissue from the margins of the tear. Debridement is done using special instruments such as rasps, shavers or basket punches. Once this is done, a fixation is initiated. In the meniscus repair surgery nonabsorbable or slowly absorbable sutures are used. Depending on the technique of suturing and suture tying, arthroscopically assisted meniscus repair surgery is called ‘inside-out‘ or ‘outside-in‘.

The most progressive technique is the third generation meniscus repair. Specific bioabsorbable devices are used to retrieve the integrity of the torn meniscus. In this technique no sutures or accessory skin incisions are needed. That is why this type of meniscus repair is also known as ‘all-inside‘ surgery.

Actually, the final decision of the type of operation is made at the time of arthroscopy when the surgeon inspects the knee joint and evaluates the damage.

Regardless of the type of technique, the surgery is carried out under the regional (spinal or epidural) or general anaesthesia.

Recovery

The meniscus repair operation does not require long postoperative hospitalization. Consequently, some patients are able to come back home the same day of operation.

In order to reduce swelling of the knee, ice compresses are administered 4 to 5 times a day right after the operation. It is important not to place the ice directly on the skin because it may cause skin damages. Additionally, keeping the operated leg elevated also reduces swelling and improves the process of recovery.

Painkillers are usually prescribed in order to reduce postoperative pain.

Moreover, it is important to immobilize the knee and keep on limited motion for about 2 weeks after the meniscus repair operation. Crutches are recommended usually for 6 weeks after the operation in order to reduce the weight bearing on the operated knee.

Although limited motion of the knee is recommended, a specific individual programme of physical therapy should begin the day after the operation. Physical therapy increases the strength of the knee and front group of the thigh muscles. Usually, a full physical therapy programme lasts about 16 weeks.

Complications

Although the success rate of meniscus repair surgery is very high and reaches about 85%, patients should be informed about the possibility of complications. There is always a risk of infection, blood vessels damaged and excessive bleeding, nerves injuries, deep vein thrombosis and risks due to anaesthesia.

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